Mass shootings unfairly stigmatizing mentally ill

By Erica D. Marshall-Lee, Ph.D.
May 31, 2019

mass shootings mental heatlhMuch information from the Internet, social media and even broadcast media gives the perception that individuals with serious mental disorders are automatically at a high risk of committing horrific violence.

Often such reports sensationalize the relationship of mental disorders to violence in a manner consistent with stigmatic personal perceptions not supported by scientific findings.

These perceptions that mental disorders are a major component in the majority of mass murders are largely based on high profile incidents of firearm shootings with multiple victims.

It is difficult to imagine that anyone who engages in mass violence could actually be sane. Obviously, we don’t think of individuals who commit these types of crimes as mentally healthy but this doesn’t necessarily mean that they have a clinically diagnosable condition.

Such horrific events inspire a desperate need to make sense of these unthinkable tragedies. High profile shootings tend to receive the most intense media coverage but are actually the least representative of gun-involved killings. In fact, mass shootings are extremely rare, accounting for only 1 percent of all firearm-related homicides in the nation.

Most firearm-related homicides are not considered exceptional enough to be nationally “newsworthy.” The extremely rare mass shootings are the stories that get attention and make the news.

The general assumption is anyone who could do such things is a person with either a longstanding serious mental disorder or an evil, murderous personality: They are “mad” or “bad.”

News media have heavily influenced the public’s perceptions of who kills and why.

Emma E. McGinty, Ph.D., MS, et al in a 2017 study found newspaper and broadcasting media mentioned violence in conjunction with mental disorders in 55 percent of gun violence stories between 1994 and 2014. They noted that mental disorders were associated with mass shooting 9 percent of the time between 1994 and 2004 and 22 percent of the time between 2005 and 2014.

Media reporting often speculates about mental status without any evidence to support it. When covering gun involved stories, it is not uncommon to hear statements such as, “Police do not know at this time if the gunman and had a history of mental disorder.”

When commenting on Devin Kelly’s November 2017 shooting of 24 people in a Texas church, President Trump stated “mental health is your problem here… This was a very deranged individual, a lot of problems over a long period of time.”

A national survey in 2006 found that 60 percent of Americans believe that people with schizophrenia are violent. A 2015 Washington Post news poll found that 63 percent of Americans blame mass shootings on a failure of the mental health system.

Practically every day we see mental health conditions linked to gun and other violence via Facebook, Twitter, magazines and broadcast news. Such messages feed an increased negative stigma around individuals with mental health challenges.

Research clearly shows most people with severe mental health concerns are not violent. Only 3 percent to 5 percent of violent events are connected to mental health status, and most of those events did not have guns involved (APA 2013).

The 2013 Institute of Medicine report on firearm-related violence indicated that the perceived threat of violence by those with mental disorders is exaggerated by the public and that overall rates of violence are comparatively small. Studies have found that people with mental health concerns are more likely to hurt themselves as opposed to harming others.

Currently, gun laws favor 2nd Amendment rights to carry arms over individual privacy and stigma. The APA advocates for an overall decrease in firearm access and not an unfair discrimination against individuals with mental health conditions.

Individuals may choose to avoid treatment altogether if they are concerned that their 2nd Amendment right will be eradicated over receiving mental health treatment. The APA recommends the removal of guns during an emergency mental health or other crisis, regardless of mental health status.

Rather than identifying a specific subgroup of people for risk assessment, such assessments should be done in a more individualized fashion. For individuals who have their guns removed during a mental health emergency or crisis, the APA suggests reinstituting their rights after a waiting period followed by a psychological evaluation and targeted violent risk assessment.

There are a number of ethical issues psychologists should consider when reflecting on mental health and gun violence. Psychologists work to protect the welfare of their consumers and the general society by fighting the promotion of negative stigma regarding having a mental disorder (Principle A: Beneficence and Nonmaleficence): (Standard 3.04 – Avoiding Harm).

Psychologists work to correct systems that engender stigma with the goal of eliminating stigma and discrimination against their consumers at all levels of society (Principle E: Respect for People’s Rights and Dignity).

Psychologists operate within established scientific and professional knowledge/information and thus resist reporting their consumers to databases that are not empirically related to an increased likelihood of violence (Standard 2.04 – Bases for Scientific and Professional Judgments) or causing harm to such individuals (Standard 3.04 – Avoiding Harm).

Psychologists work to protect the confidentiality of their consumers and view reporting a consumer’s personal information to background check registries as breaking that trust/commitment by informing third-parties of personal information disclosed in the confidential therapeutic setting.

This could disrupt the therapeutic relationship by breaching trust. Additionally, if a consumer is placed on a registry, they may associate this listing with a loss of valued privileges, embarrassment and shame with the consequence being that consumers may be less likely to disclose pertinent information or to get help (Standard 4.01 – Maintaining Confidentiality).

Psychologists are bound ethically to protect a consumer’s confidentially. However, APA ethical codes allow for confidentiality to be broken in order to observe federal and state law. This can be challenging, as laws regarding confidentiality differ from state to state (Standard 4.05 – Disclosures).

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Erica D. Marshall-Lee, Ph.D., is a clinical psychologist and assistant professor at the Emory University School of Medicine. She is clinical director at Grady Behavioral Health Services, Psychosocial Rehabilitation and Peer Support Programs in Atlanta, Ga. She credited Nadine Kaslow, Ph.D., and Keith Wood, Ph.D., for help on this article. Marshall-Lee’s email address is:

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